肝豆状核变性合并脾功能亢进患者行脾切除术中血小板水平对手术及预后的影响研究

Influence of platelet level during splenectomy in patients with hepatolenticular degeneration and hypersplenism on the operation and prognosis

目的:研究肝豆状核变性(HLD)合并脾功能亢进(脾亢)的患者在行脾切除术过程中血小板(PLT)水平对手术及预后的影响。方法:选取行脾切除术的脾亢患者244例,根据患者术前PLT计数分为A组、B组、C组三组。对术中出血量、术后总引流量以及术前、术后1、7、14 d的血红细胞(RBC)、血白细胞(WBC)、血红蛋白(HGB)、PLT、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)、凝血酶原时间(PT)及术后并发症进行统计分析。结果:术中与术后总引流量的对比中,三组间比较均无统计学差异(P>0.05);RBC、WBC、HGB、PLT、ALT、AST、TBIL、PT的对比中,三组间术后与术前比较均有明显提升(均P<0.05),但三组之间提升程度比较均无统计学差异(均P>0.05);术后并发症上的比较,术后出血上,三组比较差异均有统计学意义(均P<0.05);发热和胰瘘的并发症上三组比较均无统计学差异(均P>0.05);门静脉血栓并发症比较,C组较A组、B组差异有统计学意义(均P<0.05),而A、B组相比较无统计学差异(P>0.05)。结论:术前PLT水平即使低至30×10~9/L及以下,一般也不会影响到手术的顺利进行与术后功能恢复,所以对于PLT水平过低的脾亢患者,仍可安全的进行手术。

Objective:To study the effect of platelet level during splenectomy in patients with hepatolenticular degeneration and hypersplenism on the operation and prognosis.Methods:244 patients with hypersplenism who underwent splenectomy were divided into three groups according to PLT count before operation.The amount of intraoperative hemorrhage,the total drainage volume,RBC,WBC,HGB,PLT,ALT,AST,TBIL,PT and postoperative complications were analyzed.Results:In the comparison of intraoperative and postoperative total drainage,there was no statistical difference between the three groups(P>0.05).In the comparison of RBC,WBC,HGB,PLT,ALT,AST,TBIL and PT,there were significant improvement in the postoperative and preoperative among the three groups(all P<0.05),but there were no significant differences in the degree of improvement between the three groups(all P>0.05).The differences in postoperative bleeding between the three groups were statistically significant(all P<0.05).There were no statistically significant differences in the complications of fever and pancreatic fistula(all P>0.05).Group C was statistically different from group A and B in portal vein thrombosis(all P<0.05),but there was no significant difference between group A and B(P>0.05).Conclusion:Before the operation,even PLT is as low as 30×10~9/L,it will not affect the operation and postoperative recovery,so for the hypersplenism patients with low PLT level,the operation can still be carried out safely.